It's never too late to learn

Qualified nurses seeking extra support in learning how to deal with people who are very distressed and disturbed can breathe a sigh of relief. Researchers led by Professor Mary Chambers of Kingston University and St George's, University of London in the United Kingdom developed a new course for nurses, helping them use effective and ethically sound approaches. Partial funding for the project was granted by the EU in the amount of EUR 300 000 under the European Commission's Leonardo da Vinci Programme. The EU has awarded another EUR 200 000 to the researchers so that they could update, test and quality assure the course in 7 European countries.

The South West London and St George's Mental Health National Health Service (NHS) Trust, as well as three hospitals in Finland, are the locations where the course was already piloted. Included in the course are around 100 hours of training, as well as online learning and face–to–face instruction. The researchers say the course will be included in mental health training programmes across Europe.

The main objective of the course is to prevent qualified nurses from responding to very disturbed individuals via ineffective means like coercion (e.g. physical restraint) or significantly restricting their interaction with others. What the experts believe is that nurses should use approaches that are both effective and ethical, namely improved communication and letting people have a say in how their care and recovery process should be managed.

'This should ensure that those with mental health problems receive improved care and will help to make their treatment more effective,' Professor Chambers says, adding that initial results indicate that the training resulted in the reduction of the numbers of violent incidents in inpatient wards.

'People tend to become distressed because they're anxious and don't know what is happening to them,' she explains. 'The key thing for the nurse is to be able to understand the individual and to establish a trusting relationship with them. The relationship the nurse develops generates a feeling of respect and dignity for the person. The nurse can then help the person to understand what is happening to them. It's a much more humanistic way of dealing with the distressed person. In the pilot hospitals in Finland, it has led to a new policy on the use of coercive intervention. In future there will be much more emphasis placed on interaction and communication skills and less on control and restraint.'

Course participant Sharon Thompson, a deputy ward manager at the London–based Springfield Hospital, says: 'Most situations that lead to patients being restrained are precipitated by professionals. This course greatly assisted our self–awareness – we improved our body language which in turn helped us to present ourselves to patients in an accommodating way instead of being threatening or intimidating. Instead of resorting to restraint we were able to de–escalate the situation before restraint became necessary. It also gave us the chance to work with our peers and question each other's practice by asking why we did things the way we did.'

The project partners developed the course with the help of people with mental health problems who had themselves been subjected to coercive treatment methods. The research findings suggest that nurses' attitudes were for the most part positive.

A total of 810 nurses working in mental health in Ireland, Italy, Lithuania and Portugal were evaluated; they responded to a questionnaire about their attitudes towards people with mental health problems.

The data show that female nurses and those holding senior positions were more likely to be sympathetic towards people with mental health problems. From a geographical perspective, Portuguese nurses' attitudes were more positive while Lithuanian nurses' attitudes were more negative.

'The Lithuanian nurses' views reflected attitudes among the general public in the Baltic republic, where organisations are working to reduce the stigma of mental illness,' says Professor Chambers.

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